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Clinical Features and Associated Factors of Macrolide-Unresponsive Mycoplasma pneumonia and Efficacy Comparison Between Doxycycline, Tosufloxacin and Corticostreoid as a Second-Line Treatment (마크로라이드 불응성 마이코플라즈마 폐렴의 임상 양상 및 연관 인자와 2차 치료제로서 doxycycline, tosufloxacin 및 corticosteroid의 효능 비교)

  • Han Byeol Kang;Youngmin Ahn;Byung Wook Eun;Seungman Park
    • Pediatric Infection and Vaccine
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    • v.31 no.1
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    • pp.37-45
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    • 2024
  • Purpose: This study aimed to examine the clinical features and determinants of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMP) and to assess the differences in the time to fever resolution between doxycycline (DXC), tosufloxacin (TFX) and corticosteroid (CST) as second-line treatment. Methods: We retrospectively analyzed the medical records of patients under the age of 18 who were admitted to Nowon Eulji University Hospital between July 2018 and February 2020, diagnosed with mycoplasma pneumonia. Macrolide resistance was confirmed by detecting point mutations in the 23S rRNA gene. MUMP was clinically defined by persistent fever (≥38.0℃) lasting for 72 hours or more after the initiation of macrolide treatment. In cases of MUMP, patients were treated with an addition of CST, or the initial macrolide was replaced either DXC or TFX. Results: Out of 157 cases of mycoplasma pneumonia, 83 cases (52.9%) did not respond to macrolides. Patients with MUMP exhibited significantly higher C-reactive protein (CRP) levels (3.2±3.0 vs. 2.4±2.2 mg/dL, P=0.047), more frequent lobar/segmental infiltrations or pleural effusions (56.6% vs. 27.0%, P<0.001; 6.0% vs. 0.0%, P=0.032), and a higher prevalence of 23S rRNA gene mutations (96.4% vs. 64.6%, P<0.001) when compared to those with macrolide-susceptible M. pneumoniae pneumonia. In terms of second-line treatment, 15 patients (18.1%) responded to CST, 30 (36.1%) to DXC, and 38 (45.8%) to TFX. The time to defervescence (TTD) after initiation second-line treatment was significantly shorter in the CST group compared to the DXC (10.3±12.7 vs. 19.4±17.2 hours, P=0.003) and TFX groups (10.3±12.7 vs. 25.0±20.1 hours, P=0.043), with no significant difference observed between the DXC and TFX groups (19.4±17.2 vs. 25.0±20.1 hours, P=0.262). Conclusions: High CRP levels, the presence of positive 23S rRNA gene mutation, lobar or segmental lung infiltration, and pleural effusion observed in chest X-ray findings were significant factors associated with macrolide unresponsiveness. In this study, CST demonstrated a shorter TTD compared to DXC or TFX. Further, larger-scale prospective studies are needed to determine the optimal second-line treatment for MUMP.

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan (Fibroscan과 비교를 통한 T1 MR Relaxometry를 이용한 간섬유화의 정량적 평가)

  • Byeong Hak Sim;Suk Hee Heo;Sang Soo Shin;Seong Beom Cho;Yong Yeon Jeong
    • Journal of the Korean Society of Radiology
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    • v.81 no.2
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    • pp.365-378
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    • 2020
  • Purpose This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. Materials and Methods One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. Results PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0-F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. Conclusion PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

Imaging of Lung Metastasis Tumor Mouse Model using $[^{18}F]FDG$ Small Animal PET and CT ($[^{18}F]FDG$ 소동물 PET과 CT를 이용한 폐 전이 종양 마우스 모델의 영상화)

  • Kim, June-Youp;Woo, Sang-Keun;Lee, Tae-Sup;Kim, Kyeong-Min;Kang, Joo-Hyun;Woo, Kwang-Sun;Chung, Wee-Sup;Jung, Jae-Ho;Cheon, Gi-Jeong;Choi, Chang-Woon;Lim, Sang-Moo
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.1
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    • pp.42-48
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    • 2007
  • Purpose: The purpose of this study is to image metastaic lung melanoma model with optimal pre-conditions for animal handling by using $[^{18}F]FDG$ small animal PET and clinical CT. Materials and Methods: The pre-conditions for lung region tumor imaging were 16-22 h fasting and warming temperature at $30^{\circ}C$. Small animal PET image was obtained at 60 min postinjection of 7.4 MBq $[^{18}F]FDG$ and compared pattern of $[^{18}F]FDG$ uptake and glucose standard uptake value (SUVG) of lung region between Ketamine/Xylazine (Ke/Xy) and Isoflurane (Iso) anesthetized group in normal mice. Metastasis tumor mouse model to lung was established by intravenous injection of B16-F10 cells in C57BL/6 mice. In lung metastasis tumor model, $[^{18}F]FDG$ image was obtained and fused with anatomical clinical CT image. Results: Average blood glucose concentration in normal mice were $128.0{\pm}23.87$ and $86.0{\pm}21.65\;mg/dL$ in Ke/Xy group and Iso group, respectively. Ke/Xy group showed 1.5 fold higher blood glucose concentration than Iso group. Lung to Background ratio (L/B) in SUVG image was $8.6{\pm}0.48$ and $12.1{\pm}0.63$ in Ke/Xy group and Iso group, respectively. In tumor detection in lung region, $[^{18}F]FDG$ image of Iso group was better than that of Ke/Xy group, because of high L/B ratio. Metastatic tumor location in $[^{18}F]FDG$ small animal PET image was confirmed by fusion image using clinical CT. Conclusion: Tumor imaging in small animal lung region with $[^{18}F]FDG$ small animal PET should be considered pre-conditions which fasting, warming and an anesthesia during $[^{18}F]FDG$ uptake. Fused imaging with small animal PET and CT image could be useful for the detection of metastatic tumor in lung region.

Changes of the surface roughness depending on immersion time and powder/liquid ratio of various tissue conditioners (수종의 조직 양화재의 침수시간과 분액비에 따른 표면 거칠기의 변화)

  • Kim, Kyung-Soo;Moon, Hong-Suk;Shim, June-Sung;Jung, Moon-Kyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.108-118
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    • 2009
  • Statement of problem: Volume stability, microstructure reproducibility and fluidity along with compatibility with dental stone must be in consideration in order to use tissue conditioner as a material for functional impression. There are few studies concerning the influence of time factor in oral condition on surface roughness of the stone and optimal retention period in the oral cavity considering such changes in surface roughness. Purpose: The purpose of this study was to find out the influence of various kinds of tissue conditioner, its powder/liquid ratio and immersion time on surface roughness of the stone. Material and methods: Materials used in this study were the three kinds of tissue conditioners(Coe-Comfort, Visco-Gel, Soft-Liner) and were grouped into three: group R-mixed with standard powder/liquid ratio that was recommended by the manufacturers, group M-mixed with 20% more powder, group L-mixed with 20% less powder. Specimens were made with the size of 20 mm diameter and 2 mm width. Each tissue conditioner specimens were subdivided into 5 groups according to the immersion time(0 hour, 1 day, 3 days, 5 days, 7 days), completely immersed into artificial saliva and were stored under $37^{\circ}C$. Specimens of which the given immersion time elapsed were taken out and were poured with improved stone, making the stone specimens. Surface roughness of the stone specimens was measured by a profilometer. Results: Within the limitation of this study, the following results were drawn. 1. Major influencing factor on surface roughness of the stone model made from tissue conditioner was the retention period(contribution ratio($\rho$)=62.86%, P<.05) of the tissue conditioner in oral cavity to make functional impression. 2. In case of Coe-Comfort, higher mean surface roughness value of the stone model with statistical significance was observed compared to that of Soft-Liner and Visco-Gel as immersion time changes(P<.05). 3. In case of group L(less), higher mean surface roughness value of the stone model with statistical significance was observed compared to that of R(recommended) and M(more) group as immersion time changes(P<.05). Conclusion: We may conclude that as the retention period of time in oral cavity influences surface roughness of the stone model the most and as the kind of tissue conditioner and its P/L ratio may influence also, clinician should well understand the optimal retention period in oral cavity and choose the right tissue conditioner for the functional impression, thus making the functional impression with tissue conditioner usefully.

The Early Experience with a Laparoscopy-assisted Pylorus-preserving Gastrectomy: A Comparison with a Laparoscopy-assisted Distal Gastrectomy with Billroth-I Reconstruction (복강경 보조 유문부보존 위절제술의 초기 경험: 복강경 보조 원위부 위절제술 후 Billroth-I 재건술과의 비교)

  • Park, Jong-Ik;Jin, Sung-Ho;Bang, Ho-Yoon;Chae, Gi-Bong;Paik, Nam-Sun;Moon, Nan-Mo;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.20-26
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    • 2008
  • Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+$\beta$ lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a $2.5{\sim}3.0\;cm$ pyloric cuff and maintaining a $3.0{\sim}4.0\;cm$ distal margin for the resection. Results: The mean age for patients who underwent LAPPG and LADGBI were $59.9{\pm}9.4$ year-old and $64.1{\pm}10.0$ year-old, respectively. The sex ratio was 1.3 : 1.0 (male 5, female 4) in the LAPPG group and 2.6 : 1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes ($28.3{\pm}11.9$ versus $28.1{\pm}8.9$), operation time ($269.0{\pm}34.4$ versus $236.3{\pm}39.6$ minutes), estimated blood loss ($191.1{\pm}85.7$ versus $218.3{\pm}150.6\;ml$), time to first flatus ($3.6{\pm}0.9$ versus $3.5{\pm}0.8$ days), time to start of diet ($5.1{\pm}0.9$ versus $5.1{\pm}1.7$ days), and postoperative hospital stay ($10.1{\pm}4.0$ versus $9.2{\pm}3.0$ days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. Conclusion: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

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Estimation of Internal Motion for Quantitative Improvement of Lung Tumor in Small Animal (소동물 폐종양의 정량적 개선을 위한 내부 움직임 평가)

  • Yu, Jung-Woo;Woo, Sang-Keun;Lee, Yong-Jin;Kim, Kyeong-Min;Kim, Jin-Su;Lee, Kyo-Chul;Park, Sang-Jun;Yu, Ran-Ji;Kang, Joo-Hyun;Ji, Young-Hoon;Chung, Yong-Hyun;Kim, Byung-Il;Lim, Sang-Moo
    • Progress in Medical Physics
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    • v.22 no.3
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    • pp.140-147
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    • 2011
  • The purpose of this study was to estimate internal motion using molecular sieve for quantitative improvement of lung tumor and to localize lung tumor in the small animal PET image by evaluated data. Internal motion has been demonstrated in small animal lung region by molecular sieve contained radioactive substance. Molecular sieve for internal lung motion target was contained approximately 37 kBq Cu-64. The small animal PET images were obtained from Siemens Inveon scanner using external trigger system (BioVet). SD-Rat PET images were obtained at 60 min post injection of FDG 37 MBq/0.2 mL via tail vein for 20 min. Each line of response in the list-mode data was converted to sinogram gated frames (2~16 bin) by trigger signal obtained from BioVet. The sinogram data was reconstructed using OSEM 2D with 4 iterations. PET images were evaluated with count, SNR, FWHM from ROI drawn in the target region for quantitative tumor analysis. The size of molecular sieve motion target was $1.59{\times}2.50mm$. The reference motion target FWHM of vertical and horizontal was 2.91 mm and 1.43 mm, respectively. The vertical FWHM of static, 4 bin and 8 bin was 3.90 mm, 3.74 mm, and 3.16 mm, respectively. The horizontal FWHM of static, 4 bin and 8 bin was 2.21 mm, 2.06 mm, and 1.60 mm, respectively. Count of static, 4 bin, 8 bin, 12 bin and 16 bin was 4.10, 4.83, 5.59, 5.38, and 5.31, respectively. The SNR of static, 4 bin, 8 bin, 12 bin and 16 bin was 4.18, 4.05, 4.22, 3.89, and 3.58, respectively. The FWHM were improved in accordance with gate number increase. The count and SNR were not proportionately improve with gate number, but shown the highest value in specific bin number. We measured the optimal gate number what minimize the SNR loss and gain improved count when imaging lung tumor in small animal. The internal motion estimation provide localized tumor image and will be a useful method for organ motion prediction modeling without external motion monitoring system.

Lower Limbs Muscle Comparative Research for Verification Effect of Rehabilitation Training Program of Total Hip Arthroplasty (재활운동 프로그램에 참가한 엉덩인공관절 수술자의 하지근력 변화에 대한 비교연구)

  • Jin, Young-Wan
    • Journal of Life Science
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    • v.20 no.4
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    • pp.543-548
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    • 2010
  • The purpose of this study was to examine the differences in kinetics between 6 months of rehabilitation training and 12 months of rehabilitation training after total hip arthroplasty. 10 unilateral THA participants performed kinetic tests. Three dimensional kinematics and hip flexors and abductors electromyography (EMG) were collected during each trial. T-test was used for statistical analysis (p<0.05). There was no significant difference in EMG data between the two groups, but the mean comparison EMG data was higher in the 12 months rehabilitation training group than the 6 months rehabilitation training group. The moment value was found with motion-dependent interaction analyzing method which was used by Feltner and Dapena. There was no significant difference between moment values of the two groups. There was no significant difference between ground reaction forces of the two groups; however, there were some differences shown in Fz (vertical reaction force) between the two groups ($892{\pm}104\;N$, $820{\pm}87\;N$). The first peak impact force was about 9% lower in the 12 months group compared to the 6 months group. The second peak active force was nearly equal between the two groups. More research is necessary to determine exactly what constitutes optimal rehabilitation training biomechanics for patients with total hip arthroplasty.

A Study on Movement of the Free Face During Bench Blasting (전방 자유면의 암반 이동에 관한 연구)

  • Lee, Ki-Keun;Kim, Gab-Soo;Yang, Kuk-Jung;Kang, Dae-Woo;Hur, Won-Ho
    • Explosives and Blasting
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    • v.30 no.2
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    • pp.29-42
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    • 2012
  • Variables influencing the free face movement due to rock blasting include the physical and mechanical properties, in particular the discontinuity characteristics, explosive type, charge weight, burden, blast-hole spacing, delay time between blast-holes or rows, stemming conditions. These variables also affects the blast vibration, air blast and size of fragmentation. For the design of surface blasting, the priority is given to the safety of nearby buildings. Therefore, blast vibration has to be controlled by analyzing the free face movement at the surface blasting sites and also blasting operation needs to be optimized to improve the fragmentation size. High-speed digital image analysis enables the analyses of the initial movement of free face of rock, stemming optimality, fragment trajectory, face movement direction and velocity as well as the optimal detonator initiation system. Even though The high-speed image analysis technique has been widely used in foreign countries, its applications can hardly be found in Korea. This thesis aims at carrying out a fundamental study for optimizing the blast design and evaluation using the high-speed digital image analysis. A series of experimentation were performed at two large surface blasting sites with the rock type of shale and granite, respectively. Emulsion and ANFO were the explosives used for the study. Based on the digital images analysis, displacement and velocity of the free face were scrutinized along with the analysis fragment size distribution. In addition, AUTODYN, 2-D FEM model, was applied to simulate detonation pressure, detonation velocity, response time for the initiation of the free face movement and face movement shape. The result show that regardless of the rock type, due to the displacement and the movement velocity have the maximum near the center of charged section the free face becomes curved like a bow. Compared with ANFO, the cases with Emulsion result in larger detonation pressure and velocity and faster reaction for the displacement initiation.

Comparison Study of Water Tension and Content Characteristics in Differently Textured Soils under Automatic Drip Irrigation (자동점적관수에 의한 토성별 수분함량 및 장력 변화특성 비교 연구)

  • Kim, Hak-Jin;Ahn, Sung-Wuk;Han, Kyung-Hwa;Choi, Jin-Yong;Chung, Sun-Ok;Roh, Mi-Young;Hur, Seung-Oh
    • Journal of Bio-Environment Control
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    • v.22 no.4
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    • pp.341-348
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    • 2013
  • Maintenance of adequate soil tension or content during the period of crop growth is necessary to support optimum plant growth and yields. A better understanding of soil tension and content for precision irrigation would allow optimal soil water condition to crops and minimize the adverse effects of water stress on crop growth and development. This research reports on a comparison of soil water tension and content variations in differently textured soils over time under drip irrigation using two different water management methods, i.e. pulse time and required water irrigation methods. The pulse time-based irrigation was performed by turning the solenoid valve on and off for preset times to allow the wetting front to disperse in root zone before additional water was applied. The required water estimation method was a new water control logic designed by Rural Development Administration that applies the amount of water required based on a conversion of the measured water tension into water content. The use of the pulse time irrigation method under drip irrigation at a high tension of -20 kPa and high temperatures over $30^{\circ}C$ was not successful at maintaining moisture tensions within an appropriate range of 5 kPa because the preset irrigation times used for water control could not compensate for the change in evapotranspiration during day and night. The response time and pattern of water contents for all of the tested soils measured with capacitance-based sensor probes were faster and more direct than those of water tensions measured with porous and ceramic cup-based tensiometers when water was applied, indicating water content would be a better control variable for automatic irrigation. The required water estimation-based irrigation method provided relatively stable control of moisture tension, even though somewhat lower tension values were obtained as compared to the target tension of -20 kPa, indicating that growers could expect to be effective in controlling low tensions ranging from -10 to -20 kPa with the required water estimation system.

Study on Pretreatment Methods to Prevent Tissue Softening of Heated Onion (가열 양파의 조직 연화 방지를 위한 전처리 방법에 관한 연구)

  • Choi, Jun-Bong;Cho, Won-Il
    • Korean Journal of Food Science and Technology
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    • v.47 no.1
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    • pp.56-62
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    • 2015
  • Various pretreatment methods were evaluated to prevent tissue softening of heated onion. Changes in onion tissue firmness during heating were explained by 3-mechanism model consisting of texture hardening at low temperature ($60-80^{\circ}C$) and substrate softening at high temperature. Preheating of onion in a $Ca^{2+}$-containing solution significantly improved its texture after high-temperature heating. The improvement of firmness by preheating at low temperature was related to the formation of strong cross-linking between carboxyl groups and $Ca^{2+}$ by the action of pectin methylesterase in onion. The highest firmness was obtained by pre-heating at $70^{\circ}C$ for 120 min in 0.5% calcium solution. This result was supported by chemical analysis showing that the amount of bound calcium was the highest at $70^{\circ}C$. Further investigation should be carried out to establish the optimal conditions to prevent the softening of various vegetables.